I think the usual interpretation of #4 by surveyors and state RAI coordinators is : the resident is newly coded as a "3" if they had previously been coded as a 0,1, or 2 for the ADL, in other works requiring extensive assistance now when not before. Then when the resident becomes totally dependent for the ADL that they had been previously coded as requiring extensive assistance for (or less assist) they are newly coded as a 4 so it is a significant change criteria. Then when the activity does not occur at all any more, even when it used to be total, it is another significant change criteria. So, there are more chances for significant change than you had been interpreting, I think. ----- Original Message ----- From: "Carol O'Brien" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Wednesday, February 18, 2004 11:46 AM Subject: Re: Significant Change
> After reading domain #4, I vote no. This resident was already a 3 and thus > couldn't newly be a three or four. Am I misinterpreting? > > > >From: "Nathan" <[EMAIL PROTECTED]> > >Reply-To: [EMAIL PROTECTED] > >To: <[EMAIL PROTECTED]> > >Subject: Re: Significant Change > >Date: Wed, 18 Feb 2004 11:00:18 -0800 > > > >The RAI Manual says that a SCSA will be done when there is a decline in two > >or more of the ten domains listed below. Dressing and Personal Hygeine both > >fall within domain # 4. However, the manual states on p2-8/para 4, "This > >may > >include two changes within a particular domain." > > > >It says on p2-8/para 2, "If there is only one change, however, staff may > >still decide that the resident would benefit from an SCSA. It is important > >to remember that each resident's situation is unique and the > >interdisciplinary treatment team must make the decision as to whether or > >not > >the resident will benefit from an RAI" > > > >BOTTOM LINE - When the survey walks in, would you rather defend your > >decision to do the SCSA or the decision not to do the SCSA? Your choice. I > >would do it if it was me. > > > > > > > >1. Resident's decision-making changes from 0 or 1 to 2 or 3 for Item B4; > >2. Emergence of sad or anxious mood pattern as a problem that is not > >easily > >altered (Item E2); > >3. Increase in the number of areas where Behavioral Symptoms are coded as > >"not easily altered" (i.e., an increase in the number of code "1"s for Item > >E4B); > >4. Any decline in an ADL physical functioning area where a resident is > >newly coded as 3, 4, or 8 (Extensive assistance, Total dependency, Activity > >did not occur) for Item G1A; > >5. Resident's incontinence pattern changes from 0 or 1 to 2, 3 or 4 (Item > >H1a or b), or there was placement of an indwelling catheter (Item H3d); > >6. Emergence of unplanned weight loss problem (5% change in 30 days or 10% > >change in 180 days) (Item K3a); > >7. Emergence of a pressure ulcer at Stage II or higher, when no pressure > >ulcers were previously present at Stage II or higher (Item M2a); > >8. Resident begins to use trunk restraint or a chair that prevents rising > >when it was not used before (Items P4c and e); > >9. Overall deterioration of resident's condition; resident receives more > >support (e.g., in ADLs or decision-making) (Item Q2 = 2); > >10. Emergence of a condition or disease in which a resident is judged to > >be > >unstable (Item J5a). > > > > > > > >Nathan > > > > > > > >----- Original Message ----- > >From: "Kristen Tryba" <[EMAIL PROTECTED]> > >To: <[EMAIL PROTECTED]> > >Sent: Tuesday, February 17, 2004 9:54 AM > >Subject: RE: Significant Change > > > > > > > I Wouldn't. > > > > > > -----Original Message----- > > > From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of > > > Holly McGran > > > Sent: Wednesday, February 18, 2004 11:33 AM > > > To: AANAC List Serve (E-mail) > > > Subject: Significant Change > > > > > > > > > > > > > > > Would you do a Significant change if a resident went from a 3 to > > > a 4 in dressing and a 3 to a 4 in personal hygeine on an MDS with > > > absolutely no other change in any other areas on the MDS? Thank you in > > > advance. Holly McGran > > > /---------------------------------------------------------- > > > The Case Mix Discussion Group is a free service of the > > > American Association of Nurse Assessment Coordinators > > > "Committed to the Assessment Professional" > > > Be sure to visit the AANAC website. Accurate answers to your > > > questions posted to NAC News and FAQs. > > > For more info visit us at http://www.aanac.org > > > -----------------------------------------------------------/ > > > > > > /---------------------------------------------------------- > > > The Case Mix Discussion Group is a free service of the > > > American Association of Nurse Assessment Coordinators > > > "Committed to the Assessment Professional" > > > Be sure to visit the AANAC website. Accurate answers to your > > > questions posted to NAC News and FAQs. > > > For more info visit us at http://www.aanac.org > > > -----------------------------------------------------------/ > > > > >/---------------------------------------------------------- > >The Case Mix Discussion Group is a free service of the > > American Association of Nurse Assessment Coordinators > > "Committed to the Assessment Professional" > >Be sure to visit the AANAC website. Accurate answers to your > > questions posted to NAC News and FAQs. > > For more info visit us at http://www.aanac.org > >-----------------------------------------------------------/ > > _________________________________________________________________ > Store more e-mails with MSN Hotmail Extra Storage - 4 plans to choose from! > http://click.atdmt.com/AVE/go/onm00200362ave/direct/01/ > > /---------------------------------------------------------- > The Case Mix Discussion Group is a free service of the > American Association of Nurse Assessment Coordinators > "Committed to the Assessment Professional" > Be sure to visit the AANAC website. Accurate answers to your > questions posted to NAC News and FAQs. > For more info visit us at http://www.aanac.org > -----------------------------------------------------------/ /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/
